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Letafati A, Taghiabadi Z, Roushanzamir M, Memarpour B, Seyedi S, Farahani AV, Norouzi M, Karamian S, Zebardast A, Mehrabinia M, Ardekani OS, Fallah T, Khazry F, Daneshvar SF, Norouzi M. From discovery to treatment: tracing the path of hepatitis E virus. Virol J 2024; 21:194. [PMID: 39180020 PMCID: PMC11342613 DOI: 10.1186/s12985-024-02470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
The hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide. HEV is classified into eight genotypes, labeled HEV-1 through HEV-8. Genotypes 1 and 2 exclusively infect humans, while genotypes 3, 4, and 7 can infect both humans and animals. In contrast, genotypes 5, 6, and 8 are restricted to infecting animals. While most individuals with a strong immune system experience a self-limiting infection, those who are immunosuppressed may develop chronic hepatitis. Pregnant women are particularly vulnerable to severe illness and mortality due to HEV infection. In addition to liver-related complications, HEV can also cause extrahepatic manifestations, including neurological disorders. The immune response is vital in determining the outcome of HEV infection. Deficiencies in T cells, NK cells, and antibody responses are linked to poor prognosis. Interestingly, HEV itself contains microRNAs that regulate its replication and modify the host's antiviral response. Diagnosis of HEV infection involves the detection of HEV RNA and anti-HEV IgM/IgG antibodies. Supportive care is the mainstay of treatment for acute infection, while chronic HEV infection may be cleared with the use of ribavirin and pegylated interferon. Prevention remains the best approach against HEV, focusing on sanitation infrastructure improvements and vaccination, with one vaccine already licensed in China. This comprehensive review provides insights into the spread, genotypes, prevalence, and clinical effects of HEV. Furthermore, it emphasizes the need for further research and attention to HEV, particularly in cases of acute hepatitis, especially among solid-organ transplant recipients.
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Affiliation(s)
- Arash Letafati
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Zahra Taghiabadi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Mahshid Roushanzamir
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
- Department of Pharmacological and Biomolecular Science, University of Milan, Milan, Italy
| | - Bahar Memarpour
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
- Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Saba Seyedi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | | | - Masoomeh Norouzi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Saeideh Karamian
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Arghavan Zebardast
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Marzieh Mehrabinia
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Omid Salahi Ardekani
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Tina Fallah
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Khazry
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Samin Fathi Daneshvar
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Norouzi
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
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Aloyo J, Kiguli J, Orach CG, Kitara DL. Community overview on the differential prevalence of Hepatitis E in two sub-counties in Kitgum District, Uganda: a mixed study design. BMC Res Notes 2024; 17:209. [PMID: 39075532 PMCID: PMC11287939 DOI: 10.1186/s13104-024-06869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND An epidemic of Hepatitis E infection occurred in Kitgum district, northern Uganda in 2009. In that epidemic, more than 10,422 people were infected, and over 166 deaths were registered. Kitgum District Health Management Information Systems (HMIS) showed that Hepatitis E cases continued to occur in Mucwini more than in Kitgum Matidi sub-county despite instituting similar epidemic control measures in the two communities. The tenacity of the virus in Mucwini sub-county had remained unclear. This study aimed to assess communities' views and perspectives on the differential prevalence of Hepatitis E in the two sub-counties of Kitgum Matidi and Mucwini in northern Uganda. METHODS A mixed study using qualitative and quantitative methods was used. Four Focus group discussions and six key informant interviews were conducted with the village health teams, local council chairpersons, health workers, and community members. These participants were chosen purposively because of their expertise and experience in community health services. Face-to-face interview guides were administered to obtain detailed information on factors associated with the differential occurrence of Hepatitis E in the two sub-counties. This study was approved by a local IRB and the Uganda National Council of Science and Technology (UNCS&T). RESULTS The most substantial findings were the differences in prevention and control practices in the two communities. Residents of Mucwini were less compliant with infection, prevention, and control guidelines, and disagreements between local councilors and village health teams in Mucwini over allowances led to poor implementation and non-adherence to guidelines on community control of the epidemic. CONCLUSION A differentially higher prevalence of Hepatitis E in Mucwini than in Kitgum Matidi resulted from poor personal and community hygiene and non-adherence to behavior change communication among residents of Mucwini than their counterparts in Kitgum Matidi. The authors recommend a more proactive approach to managing an epidemic by securing the willingness of the affected community to adopt appropriate infection prevention and control guidelines. In addition, disagreements among stakeholders should be resolved quickly so that all community members adhere to control measures.
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Affiliation(s)
- Judith Aloyo
- Rhites-N, Acholi, Gulu City, Uganda
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
- Uganda Medical Association, UMA Acholi branch, Gulu City, Uganda
| | - Juliet Kiguli
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Christopher Garimoi Orach
- School of Public Health, Department of Community and Behavioral Sciences, Makerere University, Kampala, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association, UMA Acholi branch, Gulu City, Uganda.
- Gulu Centre for advanced medical diagnostics, research, trainings, and innovations (Grudi Biontech Initiative), Gulu, Uganda.
- Faculty of Medicine, Department of Surgery, Takemi fellow of Harvard University, Gulu University, P.0. Box 166, Gulu City, Uganda.
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Dighe A, Khan AI, Bhuiyan TR, Islam MT, Khan ZH, Khan II, Hulse JD, Ahmed S, Rashid M, Hossain MZ, Rashid R, Hegde ST, Gurley ES, Qadri F, Azman AS. Annual risk of hepatitis E virus infection and seroreversion: Insights from a serological cohort in Sitakunda, Bangladesh. Epidemiol Infect 2024; 152:e52. [PMID: 38497497 PMCID: PMC11022260 DOI: 10.1017/s0950268824000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/01/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14-17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10-21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2-5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5-0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.
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Affiliation(s)
- Amy Dighe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Mamunur Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Md Zakir Hossain
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Rumana Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Sonia T. Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Firdausi Qadri
- Infectious Disease Division, icddr, b, Dhaka, Bangladesh
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
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de Marguerite Nombot-Yazenguet MP, Doté JW, Koyaweda GW, Zemingui-Bembete PA, Selekon B, Vickos U, Manirakiza A, Nakoune E, Gouandjika-Vasilache I, Komas NPJ. Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019. BMC Infect Dis 2024; 24:215. [PMID: 38374096 PMCID: PMC10875899 DOI: 10.1186/s12879-024-09116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR). METHODS Blood samples were collected from 352 patients aged 0-85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis. RESULTS Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0-10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water. CONCLUSION This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.
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Affiliation(s)
| | - Joël Wilfried Doté
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Giscard Wilfried Koyaweda
- Laboratoire National de Biologie Clinique Et de Santé Publique, PO Box 1426, Bangui, Central African Republic
| | | | - Benjamin Selekon
- Arboviruses, Hemorragic Fever Viruses and Zoonosis Virus Laboratory, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Ulrich Vickos
- Department of Medicine, Infectious and Tropical Diseases Unit, Hôpital de L'Amitié Sino-Centrafricaine, Bangui, Central African Republic
| | - Alexandre Manirakiza
- Epidemiological Service, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Emmanuel Nakoune
- Arboviruses, Hemorragic Fever Viruses and Zoonosis Virus Laboratory, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
| | - Ionela Gouandjika-Vasilache
- Enteric Viruses and Measles Laboratory, Institut Pasteur de Bangui, PO Box 923, Bangui, Central African Republic
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Jaber T, Boelee E, Bleser J, Bartram JK. Outbreaks of faecal-orally transmitted diseases in displacement camps: A scoping review of pathogens, risk factors, exposure routes, and drivers of transmission. Glob Public Health 2024; 19:2380847. [PMID: 39052912 DOI: 10.1080/17441692.2024.2380847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
Many forcibly displaced people reside in camps characterised by precarious living conditions, exposing them to numerous health risks. This scoping review elucidated the risk factors and exposure routes implicated in outbreaks of faecal-oral pathogens in camps, as well as the context-specific drivers of transmission that shape these outbreaks. Journal articles were identified from PubMed, Embase, Scopus, and Web of Science. Portals for grey literature were also searched. A total of 48 records, published between 1937 and 2022, were included in the analysis. Cholera outbreaks were the most frequently reported. Risk factors included drinking water from shallow wells and rivers, consuming ice and leftover food, and inconsistent handwashing. These indicate exposure through vehicles of transmission in both public and domestic domains, emphasising the importance of a multipronged approach to outbreak prevention and control. Outbreaks were often exacerbated by extreme weather events and acute population influxes that damage or overwhelm water and sanitation facilities. Such shocks warrant explicit recommendations in preparedness and response guidelines. Development projects and outbreak response measures in surrounding areas may reduce the risk of importing pathogens into camps. Future research could further investigate faecal-oral pathogens other than Vibrio cholerae and analyse the co-occurrence of the identified transmission drivers.
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Affiliation(s)
- Tarek Jaber
- School of Business and Economics, Maastricht University, Maastricht, the Netherlands
- UNU-MERIT, Maastricht, the Netherlands
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Eline Boelee
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Julia Bleser
- Department of Freshwater Ecology and Water Quality, Deltares, Utrecht, the Netherlands
| | - Jamie K Bartram
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Civil Engineering, University of Leeds, Leeds, UK
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Cao K, Wu X, Yang M, Chen C, Zhang X, Jiang D, Du Y, Chen M, You Y, Zhou W, Qi J, Chen D, Yan R, Miao Z, Yang S. Prevalence of hepatitis E virus in China from 1997 to 2022: a systematic review and meta-analysis. Front Public Health 2023; 11:1243408. [PMID: 37744517 PMCID: PMC10512461 DOI: 10.3389/fpubh.2023.1243408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Several studies have reported on hepatitis E virus (HEV) prevalence in various regions of China, but the results vary widely. Herein, we conducted a systematic review and meta-analysis to assess the seroprevalence, RNA-positive rate, genotype distribution of HEV in China, and its risk factors. Methods We included 208 related studies involving 1,785,569 participants published between 1997 and 2022. Random-effects models were used to pool prevalence, and subgroup analyses were conducted by population, gender, age, study period, regions, and rural-urban distribution. The meta regression models and pooled odds ratios (OR) were performed to identify risk factors for HEV infections. Results The pooled anti-HEV IgG, IgM, and Ag seroprevalence, and RNA detection rates in China from 1997 to 2022 were 23.17% [95% confidence interval (CI): 20.23-26.25], 0.73% (95% CI: 0.55-0.93), 0.12% (95% CI: 0.01-0.32), and 6.55% (95% CI: 3.46-12.05), respectively. The anti-HEV IgG seropositivity was higher in the occupational population (48.41%; 95% CI: 40.02-56.85) and older adult aged 50-59 years (40.87%; 95% CI: 31.95-50.11). The dominant genotype (GT) of hepatitis E in China was GT4. Notably, drinking non-tap water (OR = 1.82; 95% CI: 1.50-2.20), consumption of raw or undercooked meat (OR = 1.47; 95% CI: 1.17-1.84), and ethnic minorities (OR = 1.50; 95% CI: 1.29-1.73) were risk factors of anti-HEV IgG seroprevalence. Discussions Overall, the prevalence of hepatitis E was relatively high in China, especially among older adults, ethnic minorities, and humans with occupational exposure to pigs. Thus, there is a need for preventive measures, including HEV infection screening and surveillance, health education, and hepatitis E vaccine intervention in high-risk areas and populations. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023397036.
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Affiliation(s)
- Kexin Cao
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyue Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengya Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Can Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Daixi Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxia Du
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengsha Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue You
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenkai Zhou
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaxing Qi
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingmo Chen
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Yan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Ziping Miao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shigui Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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Geng Y, Shi T, Wang Y. Epidemiology of Hepatitis E. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1417:33-48. [PMID: 37223857 DOI: 10.1007/978-981-99-1304-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Hepatitis E virus (HEV) is globally prevalent with relatively high percentages of anti-HEV immunoglobulin G-positive individuals in the populations of developing and developed countries. There are two distinct epidemiological patterns of hepatitis E. In areas with high disease endemicity, primarily developing countries in Asia and Africa, this disease is caused mainly by genotypes HEV-1 or HEV-2; both genotypes transmit predominantly through contaminated water and occur as either outbreaks or sporadic cases of acute hepatitis. The acute hepatitis has the highest attack rate in young adults and is particularly severe among pregnant women. In developed countries, sporadic cases of locally acquired HEV-3 or HEV-4 infection are observed. The reservoir of HEV-3 and HEV-4 is believed to be animals, such as pigs, with zoonotic transmission to humans. The affected persons are often elderly, and persistent infection has been well documented among immunosuppressed persons. A subunit vaccine has been shown to be effective in preventing clinical disease and has been licensed in China.
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Affiliation(s)
- Yansheng Geng
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
| | - Tengfei Shi
- Key Laboratory of Public Health Safety of Hebei Province, School of Public Health, Hebei University, Baoding, China
| | - Youchun Wang
- Institute of Medical Biology, Chinese Academy of Medical Science & Peking Union Medical College, Kunming, China.
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Shata MTM, Hetta HF, Sharma Y, Sherman KE. Viral hepatitis in pregnancy. J Viral Hepat 2022; 29:844-861. [PMID: 35748741 PMCID: PMC9541692 DOI: 10.1111/jvh.13725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/17/2021] [Accepted: 06/13/2022] [Indexed: 12/09/2022]
Abstract
Viral hepatitis is caused by a heterogenous group of viral agents representing a wide range of phylogenetic groups. Many viruses can involve the liver and cause liver injury but only a subset are delineated as 'hepatitis viruses' based upon their primary site of replication and tropism for hepatocytes which make up the bulk of the liver cell population. Since their discovery, beginning with the agent that caused serum hepatitis in the 1960s, the alphabetic designations have been utilized. To date, we have five hepatitis viruses, A through E, though it is postulated that others may exist. This chapter will focus on those viruses. Note that hepatitis D is included as a subset of hepatitis B, as it cannot exist without concurrent hepatitis B infection. Pregnancy has the potential to affect all aspects of these viral agents due to the unique immunologic and physiologic changes that occur during and after the gestational period. In this review, we will discuss the most common viral hepatitis and their effects during pregnancy.
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Affiliation(s)
- Mohamed Tarek M. Shata
- Division of Digestive Disease, Department of Internal MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Helal F. Hetta
- Division of Digestive Disease, Department of Internal MedicineUniversity of CincinnatiCincinnatiOhioUSA,Department of Medical Microbiology and Immunology, Faculty of MedicineAssiut UniversityAssiutEgypt
| | - Yeshika Sharma
- Division of Digestive Disease, Department of Internal MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Kenneth E. Sherman
- Division of Digestive Disease, Department of Internal MedicineUniversity of CincinnatiCincinnatiOhioUSA
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Hepatitis E Virus Seroprevalence and Associated Risk Factors in Pregnant Women Attending Antenatal Consultations in Senegal. Viruses 2022; 14:v14081742. [PMID: 36016364 PMCID: PMC9416362 DOI: 10.3390/v14081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
In West Africa, research on the hepatitis E virus (HEV) is barely covered, despite the recorded outbreaks. The low level of access to safe water and adequate sanitation is still one of the main factors of HEV spread in developing countries. HEV infection induces acute or sub-clinical liver diseases with a mortality rate ranging from 0.5 to 4%. The mortality rate is more alarming (15 to 25%) among pregnant women, especially in the last trimester of pregnancy. Herein, we conducted a multicentric socio-demographic and seroepidemiological survey of HEV in Senegal among pregnant women. A consecutive and non-redundant recruitment of participants was carried out over the period of 5 months, from March to July 2021. A total of 1227 consenting participants attending antenatal clinics responded to a standard questionnaire. Plasma samples were collected and tested for anti-HEV IgM and IgG by using the WANTAI HEV-IgM and IgG ELISA assay. The overall HEV seroprevalence was 7.8% (n = 96), with 0.5% (n = 6) and 7.4% (n = 91) for HEV IgM and HEV IgG, respectively. One of the participant samples was IgM/IgG-positive, while four were declared indeterminate to anti-HEV IgM as per the manufacturer’s instructions. From one locality to another, the seroprevalence of HEV antibodies varied from 0 to 1% for HEV IgM and from 1.5 to 10.5% for HEV IgG. The data also showed that seroprevalence varied significantly by marital status (p < 0.0001), by the regularity of income (p = 0.0043), and by access to sanitation services (p = 0.0006). These data could serve as a basis to setup national prevention strategies focused on socio-cultural, environmental, and behavioral aspects for a better management of HEV infection in Senegal.
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Ciglenecki I, Rumunu J, Wamala JF, Nkemenang P, Duncker J, Nesbitt R, Gignoux E, Newport T, Heile M, Jamet C, Rull M, Azman AS. The first reactive vaccination campaign against hepatitis E. THE LANCET. INFECTIOUS DISEASES 2022; 22:1110-1111. [PMID: 35870452 DOI: 10.1016/s1473-3099(22)00421-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 01/22/2023]
Affiliation(s)
| | - John Rumunu
- Ministry of Public Health, Juba, South Sudan
| | | | | | | | | | | | | | - Melat Heile
- Médecins Sans Frontières, 1202 Geneva, Switzerland
| | | | - Monica Rull
- Médecins Sans Frontières, 1202 Geneva, Switzerland
| | - Andrew S Azman
- Médecins Sans Frontières, 1202 Geneva, Switzerland; John Hopkins University, Baltimore, MD, USA
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11
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Mpundu P, Muma JB, Mukumbuta N, Mukubesa AN, Muleya W, Kapila P, Hang'ombe BM, Munyeme M. Isolation, discrimination, and molecular detection of Listeria species from slaughtered cattle in Namwala District, Zambia. BMC Microbiol 2022; 22:160. [PMID: 35717165 PMCID: PMC9206240 DOI: 10.1186/s12866-022-02570-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The food industry is increasingly becoming more scrutinized, given the frequency and intensity with which zoonotic diseases are being reported. Pathogen tracking has become more applicable with regards food safety. It is in this regard that the present study was formulated to track Listeria species. in freshly slaughtered cattle carcasses by utilizing standard and molecular biological techniques. METHODS A cross-sectional study design was conducted from March to December 2020 with 200 samples being equally collected in the rainy and dry seasons. A total of 180 and 20 swabs were aseptically collected from carcasses and the environment respectively. Samples were first subjected to pre-enrichment in half-strength Fraser broth followed by enrichment in full strength Fraser broth and subsequent plating on Listeria agar. Listeria growth characteristics were identified up to species level based on their morphological and biochemical characteristics. Further, molecular detection and phylogenetic analysis was conducted. Quantitative proportionate survey data were analyzed using Stata Version 15 software to estimate crude prevalence taking into account complex design at abattoir level. Factors associated with contamination were characterized using logistic regression. Sequences were analyzed using, Genetyyx version 12 and phylogenetic Mega. RESULTS Of the 200 samples, 19 were positive for Listeria species identified as L.innocua 14/19 (73.7%) and L. monocytogenes 5/19 (26.3%). All isolates were from freshly slaughtered carcasses, and none from environment. Siginificant differences in contamination levels were observed based on season: rainy season yielded 14 (73.6%) whilst the dry season 5 (26.3%). The L. monocytogenes strains showed a high degree of homogeneity on phylogenetic analysis and clustered based on abattoir. Seasonality was identified as a major determinant influencing contamination based on the final logistic regression model. CONCLUSION This study found evidence of L. monocytogenes contamination on traditionally raised beef carcasses across various abattoirs surveyed. The failure to find Listeria contamination on the abattoir environment may to a greater extent intimate cattle carccases as primary sources of contamination. However, a more comprerehnsive study incorporating different geographical regions is needed to conclusively ascertain these present findings.
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Affiliation(s)
- Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka, 33991, Zambia. .,Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia.
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
| | - Nawa Mukumbuta
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka, 33991, Zambia.,Department of Epidemiology and Biostatics, Levy Mwanawasa Medical University, Lusaka, 33991, Zambia
| | - Andrew Nalishuwa Mukubesa
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
| | - Walter Muleya
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
| | - Penjaninge Kapila
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
| | - Bernard Mudenda Hang'ombe
- Department of Para-Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, 10101, Zambia
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12
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Raji YE, Toung OP, Taib NM, Sekawi ZB. Hepatitis E Virus: An emerging enigmatic and underestimated pathogen. Saudi J Biol Sci 2022; 29:499-512. [PMID: 35002446 PMCID: PMC8716866 DOI: 10.1016/j.sjbs.2021.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatitis E virus (HEV) is an RNA virus causing hepatitis E disease. The virus is of one serotype but has diverse genotypes infecting both humans and animals. Based on evidence from seroprevalence studies, about 2 billion people are estimated to have been infected with HEV globally. HEV, therefore, poses a significant public health and economic challenge worldwide. HEV was discovered in the 1980s and was traced back to the 1955 - 1956 outbreak of hepatitis that occurred in India. Subsequently, several HEV epidemics involving thousands of individuals have occurred nearly annually in different countries in Asia and Africa. Initially, the virus was thought to be only enterically transmitted, and endemic in developing countries. Due to the environmental hygiene and sanitation challenges in those parts of the world. However, recent studies have suggested otherwise with the report of autochthonous cases in industrialised countries with no history of travel to the so-called endemic countries. Thus, suggesting that HEV has a global distribution with endemicity in both developing and industrialised nations. Studies have also revealed that HEV has multiple risk factors, and modes of transmission as well as zoonotic potentials. Additionally, recent findings have shown that HEV leads to severe disease, particularly among pregnant women. In contrast to the previous narration of a strictly mild and self-limiting infection. Studies have likewise demonstrated chronic HEV infection among immunocompromised persons. Consequent to these recent discoveries, this pathogen is considered a re - emerging virus, particularly in the developed nations. However, despite the growing public health challenges of this pathogen, the burden is still underestimated. The underestimation is often attributed to poor awareness among clinicians and a lack of routine checks for the disease in the hospitals. Thus, leading to misdiagnosis and underdiagnosis. Hence, this review provides a concise overview of epidemiology, diagnosis, and prevention of hepatitis E.
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Affiliation(s)
- Yakubu Egigogo Raji
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
- Faculty of Natural and Applied Sciences Ibrahim Badamasi Babangida University, Lapai, Nigeria
| | - Ooi Peck Toung
- Department of Veterinary Clinical Studies Faculty of Veterinary Medicine, Universiti Putra Malaysia 2, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
| | - Zamberi Bin Sekawi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
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13
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Prevalence and Diversity of Hepatitis Virus Markers among Patients with Acute Febrile Jaundice in Chad. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Only a minority of the patients with acute febrile jaundice evaluated through the Yellow Fever surveillance program were found positive for antibodies against Yellow Fever Virus (YFV). In order to characterize patients with acute febrile jaundice negative for YFV, we collected 255 sera between January to December 2019. We screened for HBV antigens, and antibodies against HCV and HEV. The seroprevalences observed were 10.6% (27/255) for HBV, 2% (5/255) for HCV, 17.3% (44/255) for HEV IgG, 4.3% (11/255) for HEV IgM, and 12.5% (32/255) for both IgG and IgM HEV. Prevalence of HEV was significantly higher in females than males (p < 0.01). HEV IgG prevalence was highest in those 20–29 years old, but the highest incidence rate (IgM positive) was in children 0–9 years old. Exposure to HEV was higher in the Sahelian zone (55.8%, 95% CI: 40.97–70.66) than in the Sudanese zone (30.2%, 95% CI: 24.01–36.37, p = 0.003). The high prevalence rates and hepatitis virus diversity underline the challenge of routine clinical diagnosis in Chad’s Yellow Fever surveillance program.
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14
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Babiker NA, Abakar AD, Mohamed NT, Abuzeid N, Modawe G, Iesa MA, Assil S, Osman H, Hamed M, Ahmed MH. Relative risk factors for seropositive hepatitis E virus among blood donors and haemodialysis patients: The pivotal role of primary health care education. J Family Med Prim Care 2021; 10:2655-2660. [PMID: 34568151 PMCID: PMC8415677 DOI: 10.4103/jfmpc.jfmpc_2441_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/28/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Hepatitis E virus is a zoonotic virus with a worldwide epidemic outbreak. The aim of the study was to identify relative risk factors and co-infections concerning the seropositive HEV IgG among blood donors and haemodialysis (HD) patients in the central blood bank and renal dialysis centre in Wad Medani city, Gezira State, Sudan. Materials and Methods: This was a cross-sectional study that included 600 participants, among them 180 showed strong seropositive HEV IgG. The structured questionnaire was used to collect data of the participants’ demographics, disease risk factors and HEV IgG co-infections with HBV, HCV, HIV and syphilis. Results: Among the 180 strong seropositive HEV IgG respondents, 84 were blood donors and 96 were haemodialysis patients. The gender and age (18–30 years) had a significant association with the virus exposure (P = 0.000, P = 0.000). Importantly, a significant association of HEV prevalence due to the localities effect exhibited with the highest rate among South Gezira (OR = 38, CI = 14.1–107; P = 0.000). This also observed in Wad Medani, Umm Algura, East Gezira and Managil localities (P = 0.000). The effect of the animal contact on HEV distribution exerted the significant association among the respondents for blood donors and haemodialysis patients in univariate (OR = 4.09, 95% CI 1.5–10.9; P = 0.005) and multivariate (OR = 3.2, CI = 1.1–9.4; P = 0.027) analysis. Conclusion: The relative risk factors of the HEV seroprevalence were gender, age, locality and animal contact. Besides the need of a regular survey for the virus seroprevalence, primary health care physicians can play pivotal role in health education, especially in rural areas of Sudan. In addition, primary health care physicians in Sudan are expected to establish strategies and plans to eradicate and minimise the health impact of HEV.
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Affiliation(s)
- Nassir A Babiker
- Wad Medani Teaching Hospital for Obstetrics and Gynaecology, Gezira State, Sudan
| | - Adam D Abakar
- Department of Medical Parasitology, Faculty of Medical Laboratory Science, Gezira University, Wad Madani, Sudan
| | - Nawal T Mohamed
- Department of Parasitology, NPHL Research Unit, Khartoum, Sudan
| | - Nadir Abuzeid
- Department of Microbiology, Faculty of Medical Laboratory Sciences, Khartoum, Sudan
| | - GadAllah Modawe
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed A Iesa
- Department of Physiology, Al Qunfudah Medical College, Umm Al Qura University, Al Qunfudah, Kingdom of Saudi Arabia
| | - Sami Assil
- Department of Community Medicine, Al Baha University, Al Bahah, Kingdom of Saudi Arabia
| | - Hisham Osman
- Department of Gastroenterology, King's Mill Hospital, Sutton-In-Ashfield, Nottinghamshire, United Kingdom
| | - Mohamed Hamed
- Department of Gastroenterology, Inverclyde Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom
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15
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Azman AS, Paul KK, Bhuiyan TR, Koyuncu A, Salje H, Qadri F, Gurley ES. Hepatitis E in Bangladesh: Insights from a National Serosurvey. J Infect Dis 2021; 224:S805-S812. [PMID: 34549775 PMCID: PMC8687073 DOI: 10.1093/infdis/jiab446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hepatitis E virus (HEV) genotypes 1 and 2 are a major cause of avoidable morbidity and mortality in South Asia. Despite the high risk of death among infected pregnant women, scarce incidence data has been a contributing factor to global policy recommendations against the introduction of licensed hepatitis E vaccines, one of the only effective prevention tools. Methods We tested serum from a nationally representative serosurvey in Bangladesh for anti-HEV immunoglobulin G and estimated seroprevalence. We used Bayesian geostatistical models to generate high-resolution maps of seropositivity and examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of 20% (95% confidence interval [CI], 17%–24%). Seropositivity increased with age and male sex (odds ratio, 2.2 male vs female; 95% CI, 1.8–2.8). Community-level seroprevalence ranged widely (0–78%) with higher seroprevalence in urban areas, including Dhaka, with a 3.0-fold (95% credible interval, 2.3–3.7) higher seroprevalence than the rest of the country. Conclusions Hepatitis E infections are common throughout Bangladesh. Strengthening surveillance for hepatitis E, especially in urban areas, can provide additional evidence to appropriately target interventions.
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Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Aybüke Koyuncu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,University of Cambridge, Cambridge, UK
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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16
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Braam DH, Jephcott FL, Wood JLN. Identifying the research gap of zoonotic disease in displacement: a systematic review. Glob Health Res Policy 2021; 6:25. [PMID: 34271977 PMCID: PMC8283393 DOI: 10.1186/s41256-021-00205-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Outbreaks of zoonotic diseases that transmit between animals and humans, against a backdrop of increasing levels of forced migration, present a major challenge to global public health. This review provides an overview of the currently available evidence of how displacement may affect zoonotic disease and pathogen transmission, with the aim to better understand how to protect health and resilience of displaced and host populations. Methods A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Between December 2019 - February 2020, PubMed, Web of Science, PLoS, ProQuest, Science Direct and JSTOR were searched for literature. Studies were included based on a focus on zoonotic disease risks in displacement and/or humanitarian emergencies, and relevance in terms of livestock dependency of the displaced populations. Evidence was synthesised in form of a table and thematic analysis. Results Of all records, 78 papers were selected for inclusion. Among the included studies, the majority were based on secondary data, including literature reviews (n=43) and case studies (n=5), while the majority of papers covered wide geographical areas such as the Global South (n=17) and Africa (n=20). The review shows significant gaps in the literature, which is specifically lacking primary data on zoonotic diseases in displacement. Risk factors for the transmission of zoonoses in displacement are based on generic infectious disease risks, which include the loss of health services, increased population density, changes in environment, reduced quality of living conditions and socio-economic factors. Regardless of the presence of these disease drivers during forced migration however, there is little evidence of large-scale zoonotic disease outbreaks linked directly to livestock in displacement. Conclusion Due to the lack of primary research, the complex interlinkages of factors affecting zoonotic pathogen transmission in displacement remain unclear. While the presence of animals may increase the burden of zoonotic pathogens, maintaining access to livestock may improve livelihoods, nutrition and mental health, with the potential to reduce people’s vulnerability to disease. Further primary interdisciplinary and multi-sectoral research is urgently required to address the evidence gaps identified in this review to support policy and program development. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00205-3.
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Affiliation(s)
- Dorien Hanneke Braam
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - Freya Louise Jephcott
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - James Lionel Norman Wood
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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17
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Cavalerie L, Wardeh M, Lebrasseur O, Nanyingi M, McIntyre KM, Kaba M, Asrat D, Christley R, Pinchbeck G, Baylis M, Mor SM. One hundred years of zoonoses research in the Horn of Africa: A scoping review. PLoS Negl Trop Dis 2021; 15:e0009607. [PMID: 34270551 PMCID: PMC8318308 DOI: 10.1371/journal.pntd.0009607] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/28/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One Health is particularly relevant to the Horn of Africa where many people's livelihoods are highly dependent on livestock and their shared environment. In this context, zoonoses may have a dramatic impact on both human and animal health, but also on country economies. This scoping review aimed to characterise and evaluate the nature of zoonotic disease research in the Horn region. Specifically, it addressed the following questions: (i) what specific zoonotic diseases have been prioritised for research, (ii) what data have been reported (human, animal or environment), (iii) what methods have been applied, and (iv) who has been doing the research? METHODOLOGY/PRINCIPAL FINDINGS We used keyword combinations to search online databases for peer-reviewed papers and theses. Screening and data extraction (disease, country, domain and method) was performed using DistillerSR. A total of 2055 studies focusing on seven countries and over 60 zoonoses were included. Brucellosis attracted the highest attention in terms of research while anthrax, Q fever and leptospirosis have been comparatively under-studied. Research efforts did not always align with zoonoses priorities identified at national levels. Despite zoonoses being a clear target for 'One Health' research, a very limited proportion of studies report data on the three domains of human, animal and environment. Descriptive and observational epidemiological studies were dominant and only a low proportion of publications were multidisciplinary. Finally, we found that a minority of international collaborations were between Global South countries with a high proportion of authors having affiliations from outside the Horn of Africa. CONCLUSIONS/SIGNIFICANCE There is a growing interest in zoonoses research in the Horn of Africa. Recommendations arising from this scoping review include: (i) ensuring zoonoses research aligns with national and global research agendas; (ii) encouraging researchers to adopt a holistic, transdisciplinary One Health approach following high quality reporting standards (COHERE, PRISMA, etc.); and (iii) empowering local researchers supported by regional and international partnerships to engage in zoonoses research.
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Affiliation(s)
- Lisa Cavalerie
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Maya Wardeh
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Department of Mathematical Sciences, University of Liverpool, Peach Street, Liverpool, United Kingdom
| | - Ophélie Lebrasseur
- International Livestock Research Institute, Addis Ababa, Ethiopia
- Department of Archaeology, Classics and Egyptology; School of Histories, Language and Cultures, University of Liverpool, Liverpool, United Kingdom
| | - Mark Nanyingi
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Department of Epidemiology and Public Health, School of Public Health, University of Nairobi, Nairobi, Kenya
| | - K. Marie McIntyre
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert Christley
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Gina Pinchbeck
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
| | - Matthew Baylis
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Siobhan M. Mor
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
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18
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Koyuncu A, Mapemba D, Ciglenecki I, Gurley ES, Azman AS. Setting a Course for Preventing Hepatitis E in Low and Lower-Middle-Income Countries: A Systematic Review of Burden and Risk Factors. Open Forum Infect Dis 2021; 8:ofab178. [PMID: 34113684 PMCID: PMC8186248 DOI: 10.1093/ofid/ofab178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/09/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is responsible for outbreaks of acute jaundice in Africa and Asia, many of which occur among displaced people or in crisis settings. Although an efficacious vaccine for HEV has been developed, we lack key epidemiologic data needed to understand how best to use the vaccine for hepatitis E control in endemic countries. METHODS We conducted a systematic review of articles published on hepatitis E in low-income and lower-middle-income countries in Africa and Asia. We searched PubMed, Scopus, and Embase databases to identify articles with data on anti-HEV immunoglobulin (Ig)G seroprevalence, outbreaks of HEV, or risk factors for HEV infection, disease, or death, and all relevant data were extracted. Using these data we describe the evidence around temporal and geographical distribution of HEV transmission and burden. We estimated pooled age-specific seroprevalence and assessed the consistency in risk factor estimates. RESULTS We extracted data from 148 studies. Studies assessing anti-HEV IgG antibodies used 18 different commercial assays. Most cases of hepatitis E during outbreaks were not confirmed. Risk factor data suggested an increased likelihood of current or recent HEV infection and disease associated with fecal-oral transmission of HEV, as well as exposures to blood and animals. CONCLUSIONS Heterogeneity in diagnostic assays used and exposure and outcome assessment methods hinder public health efforts to quantify burden of disease and evaluate interventions over time and space. Prevention tools such as vaccines are available, but they require a unified global strategy for hepatitis E control to justify widespread use.
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Affiliation(s)
| | - Daniel Mapemba
- South African Field Epidemiology Training Program, National Institute for Communicable Diseases, Division of National Health Laboratory Services, Johannesburg, South Africa
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Kirkwood CD, Dobscha KR, Steele AD. Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention. Expert Rev Vaccines 2021; 19:1129-1140. [PMID: 33441054 DOI: 10.1080/14760584.2020.1874930] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hepatitis E virus (HEV) is an important cause of enterically transmitted viral hepatitis and a significant contributor to maternal mortality in endemic regions around the world, yet the global response has been limited. HEV is a disease of poverty, and the populations experiencing the greatest burden of HEV-associated illness are not benefitting from existing interventions, including WASH strategies and immunization. AREAS COVERED Though a vaccine exists (HEV 239, Hecolin®, Xiamen Innovax Biotech, China), it is only licensed and available in the private market in China and has yet to be prequalified by the WHO for use in endemic settings and outbreaks. This review of the current state of HEV disease and subsequent recommendations for a coordinated public health response are intended to guide the global health community towards breaking the current 'vicious cycle,' in which a lack of data prevents actions that would improve health outcomes. EXPERT OPINION Vaccine implementation in future outbreaks, targeted studies assessing vaccine effectiveness and immunogenicity in endemic regions and populations, improved understanding of the global burden, and improvements in diagnostic and epidemiologic tools are urgently needed. Strategies for implementing routine vaccination programs, improving water, sanitation, and hygiene in endemic regions.
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Affiliation(s)
- Carl D Kirkwood
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
| | - Katherine R Dobscha
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
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Modiyinji AF, Bigna JJ, Kenmoe S, Simo FBN, Amougou MA, Ndangang MS, Nola M, Njouom R. Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis. BMC Vet Res 2021; 17:50. [PMID: 33494758 PMCID: PMC7831161 DOI: 10.1186/s12917-021-02749-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. METHODS In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. RESULTS Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0-37.2) for anti-HEV immunoglobulins G, 13.1% (3.1-28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2-4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9-65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). CONCLUSIONS We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.
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Affiliation(s)
- Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,Department of Biology and Animal Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,School of Public Health, Faculty of Medicine, University of Paris Sud, Le Kremlin-Bicêtre, France
| | - Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Fredy Brice N Simo
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Marie A Amougou
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Marie S Ndangang
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Moise Nola
- Department of Biology and Animal Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon.
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21
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Berhan Y. What immunological and hormonal protective factors lower the risk of COVID-19 related deaths in pregnant women? J Reprod Immunol 2020; 142:103180. [PMID: 32739645 PMCID: PMC7368414 DOI: 10.1016/j.jri.2020.103180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Despite anticipated increased risk of COVID-19 and increased expression of the SARS CoV-2 receptor (ACE2), the relatively low mortality of pregnant women with COVID-19 has been an area of wonder. The immunological changes predominantly inclining to anti-inflammatory state, which is augmented by placental hormones' immune modulating action, looks against with COVID-19 inflammatory reaction leading to cytokine storm and multiple organ failure. Unlike many other viral infections, the bilateral immune activation of COVID-19 may preferentially make pregnant women at low risk. Taking the physiological advantage of pregnant women, potential clinical trials are proposed. Quite a large number of epidemiological and obstetrics related studies have addressed the cases of women with COVID-19. However, to the best of the author's knowledge, little is done to explore the physiological internal milieu of pregnant women in relation to COVID-19. This review provides an insight into how the hormonal and immunological changes in pregnancy potentially reduce SARS-CoV-2-mediated inflammatory response.
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Affiliation(s)
- Yifru Berhan
- St. Paul's Hospital Millennium Medical College, Ethiopia.
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22
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Pallerla SR, Harms D, Johne R, Todt D, Steinmann E, Schemmerer M, Wenzel JJ, Hofmann J, Shih JWK, Wedemeyer H, Bock CT, Velavan TP. Hepatitis E Virus Infection: Circulation, Molecular Epidemiology, and Impact on Global Health. Pathogens 2020; 9:E856. [PMID: 33092306 PMCID: PMC7589794 DOI: 10.3390/pathogens9100856] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Infection with hepatitis E virus (HEV) represents the most common source of viral hepatitis globally. Although infecting over 20 million people annually in endemic regions, with major outbreaks described since the 1950s, hepatitis E remains an underestimated disease. This review gives a current view of the global circulation and epidemiology of this emerging virus. The history of HEV, from the first reported enteric non-A non-B hepatitis outbreaks, to the discovery of the viral agent and the molecular characterization of the different human pathogenic genotypes, is discussed. Furthermore, the current state of research regarding the virology of HEV is critically assessed, and the challenges towards prevention and diagnosis, as well as clinical risks of the disease described. Together, these points aim to underline the significant impact of hepatitis E on global health and the need for further in-depth research to better understand the pathophysiology and its role in the complex disease manifestations of HEV infection.
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Affiliation(s)
- Srinivas Reddy Pallerla
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi 100000, Vietnam
| | - Dominik Harms
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany;
| | - Reimar Johne
- Unit Viruses in Food, Department Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany;
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801 Bochum, Germany; (D.T.); (E.S.)
- European Virus Bioinformatics Center (EVBC), 07743 Jena, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801 Bochum, Germany; (D.T.); (E.S.)
| | - Mathias Schemmerer
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.S.); (J.J.W.)
| | - Jürgen J. Wenzel
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.S.); (J.J.W.)
| | - Jörg Hofmann
- Institute of Virology, Charité Universitätsmedizin Berlin, Labor Berlin-Charité-Vivantes GmbH, 13353 Berlin, Germany;
| | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30623 Hannover, Germany;
- German Center for Infection Research, Partner Hannover-Braunschweig, 38124 Braunschweig, Germany
| | - C.-Thomas Bock
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany;
| | - Thirumalaisamy P. Velavan
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi 100000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
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23
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Bagulo H, Majekodunmi AO, Welburn SC. Hepatitis E in Sub Saharan Africa - A significant emerging disease. One Health 2020; 11:100186. [PMID: 33204807 PMCID: PMC7653283 DOI: 10.1016/j.onehlt.2020.100186] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022] Open
Abstract
Hepatitis E is an emerging endemic disease found across the African continent, but there are clear differences in epidemiology between North Africa and countries south of the Sahara. In this systematic review, Google scholar and PubMed databases were searched for peer-reviewed articles on HEV epidemiology. Publications meeting our inclusion criteria were critically reviewed to extract consistent findings and identify knowledge gaps. Hepatitis E has been reported in 25 of the 49 countries in Sub Saharan Africa. Mortality rates of 1–2% in the general population and ~ 20% in pregnant women. Outbreaks were closely linked to refugees and Internally Displaced Persons in camps which accounted for 50% of reported outbreaks. There was very little research and concrete evidence for sources of contamination and transmission routes. There are indications of zoonotic transmission of Hepatitis E Virus infection but further research in these fields is required. No data from 50% of African countries Outbreaks closely linked to refugee and IDP camps Little data on sources of HEV contamination Indications but little evidence of zoonotic transmission Low awareness amongst health professionals and general public
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Affiliation(s)
- Husein Bagulo
- Zhejiang University - University of Edinburgh Institute, Zhejiang University International Campus, 718 East Haizhou Rd, Haining, Zhejiang Province, 314400, China.,Livestock and Poultry Research Centre, College of Basic and Applied Sciences, University of Ghana, P. O Box LG 25, Legon, Accra, Ghana
| | - Ayodele O Majekodunmi
- Zhejiang University - University of Edinburgh Institute, Zhejiang University International Campus, 718 East Haizhou Rd, Haining, Zhejiang Province, 314400, China.,Livestock and Poultry Research Centre, College of Basic and Applied Sciences, University of Ghana, P. O Box LG 25, Legon, Accra, Ghana.,School of Biomedical Sciences, Edinburgh Medical School, College of Medicine & Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh EH8 9JZ, United Kingdom
| | - Susan C Welburn
- Zhejiang University - University of Edinburgh Institute, Zhejiang University International Campus, 718 East Haizhou Rd, Haining, Zhejiang Province, 314400, China.,School of Biomedical Sciences, Edinburgh Medical School, College of Medicine & Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh EH8 9JZ, United Kingdom
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24
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Oluremi AS, Ajadi TA, Opaleye OO, Alli OAT, Ogbolu DO, Enitan SS, Alaka OO, Adelakun AA, Adediji IO, Ogunleke AO, Suleiman IE, Olowoyeye EA, Adewumi OO, Ojo AT, Adeyeye-Adetunji OO, Hammed SS. High seroprevalence of viral hepatitis among animal handlers in Abeokuta, Ogun State, Nigeria. J Immunoassay Immunochem 2020; 42:34-47. [PMID: 33044898 DOI: 10.1080/15321819.2020.1814810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Viral hepatitis is a deadly disease which can manifest as acute, chronic, hepatocellular carcinoma, and liver failure. Information about hepatitis is scarce among animal handlers. Due to Federal Government of Nigeria diversification programmes, many people are now involved in animal farming which can make them susceptible to viral hepatitis. This study aimed at determining the prevalence of Hepatitis B, C, and E viruses among animal handlers in Abeokuta, southwestern Nigerian. A total of 156 subjects were recruited for the study. Sociodemographic and risks factors data were fetched from subjects using interviewer-administered questionnaire. Blood samples were collected via venepuncture and tested for HCV, HBV, and HEV using ELISA technique. Results were analyzed using SPSS software version 21.0 and P value ≤ 0.05 was considered significant. The prevalence of HCV, HBV, and HEV were 46 (29.5%), 20 (12.8%), and 4 (2.6%) respectively while 6 (3.8%), 1 (0.6%), and 1 (0.6%) had co-infection of HBV-HCV, HBV-HEV, and HCV- HEV respectively. This study concludes that there is high prevalence of hepatitis C and B viruses among animal handlers in Abeokuta, Ogun state which is of significant public health problem, warranting further attention and research.
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Affiliation(s)
- A S Oluremi
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria.,Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.,Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - T A Ajadi
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - O O Opaleye
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - O A T Alli
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - D O Ogbolu
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - S S Enitan
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - O O Alaka
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria
| | - A A Adelakun
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - I O Adediji
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - A O Ogunleke
- LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
| | - I E Suleiman
- Department of Chemical Pathology & Immunology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - E A Olowoyeye
- College of Health Sciences & Technology, Ijero Ekiti, Nigeria
| | | | - A T Ojo
- LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
| | | | - S S Hammed
- Federal Medical Centre, Abeokuta, Ogun State, Nigeria
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25
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Li M, Yang Y, Lu Y, Zhang D, Liu Y, Cui X, Yang L, Liu R, Liu J, Li G, Qu J. Natural Host-Environmental Media-Human: A New Potential Pathway of COVID-19 Outbreak. ENGINEERING (BEIJING, CHINA) 2020; 6:1085-1098. [PMID: 33520330 PMCID: PMC7834166 DOI: 10.1016/j.eng.2020.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 05/05/2023]
Abstract
Identifying the first infected case (patient zero) is key in tracing the origin of a virus; however, doing so is extremely challenging. Patient zero for coronavirus disease 2019 (COVID-19) is likely to be permanently unknown. Here, we propose a new viral transmission route by focusing on the environmental media containing viruses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or RaTG3-related bat-borne coronavirus (Bat-CoV), which we term the "environmental quasi-host." We reason that the environmental quasi-host is likely to be a key node in helping recognize the origin of SARS-CoV-2; thus, SARS-CoV-2 might be transmitted along the route of natural host-environmental media-human. Reflecting upon viral outbreaks in the history of humanity, we realize that many epidemic events are caused by direct contact between humans and environmental media containing infectious viruses. Indeed, contacts between humans and environmental quasi-hosts are greatly increasing as the space of human activity incrementally overlaps with animals' living spaces, due to the rapid development and population growth of human society. Moreover, viruses can survive for a long time in environmental media. Therefore, we propose a new potential mechanism to trace the origin of the COVID-19 outbreak.
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Affiliation(s)
- Miao Li
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Yunfeng Yang
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Yun Lu
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Dayi Zhang
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Yi Liu
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Xiaofeng Cui
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Lei Yang
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Ruiping Liu
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Jianguo Liu
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Guanghe Li
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Jiuhui Qu
- School of Environment, Tsinghua University, Beijing 100084, China
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
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26
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Lenglet A, Ehlkes L, Taylor D, Fesselet JF, Nassariman JN, Ahamat A, Chen A, Noh I, Moustapha A, Spina A. Does community-wide water chlorination reduce hepatitis E virus infections during an outbreak? A geospatial analysis of data from an outbreak in Am Timan, Chad (2016-2017). JOURNAL OF WATER AND HEALTH 2020; 18:556-565. [PMID: 32833681 DOI: 10.2166/wh.2020.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hepatitis E Virus (HEV) genotype 1 and 2 infect an estimated 20 million people each year, via the faecal-oral transmission route. An urban outbreak of HEV occurred in Am Timan, Chad, between September 2016 and April 2017. As part of the outbreak response, Médecins Sans Frontières and the Ministry of Health implemented water and hygiene interventions, including the chlorination of town water sources. We aimed to understand whether these water treatment activities had any impact on the number of HEV infections, using geospatial analysis of epidemiological and water treatment monitoring data. By conducting cluster analysis we investigated whether there were areas of particularly high and low infection risk during the outbreak and explored the reasons for this. We observed two high-risk spatial clusters of suspected cases and one high-risk cluster of confirmed cases. Our main finding was that confirmed HEV cases had a higher median number of days of exposure to unsafe water compared to suspected and non-confirmed cases (Kruskal-Wallis Chi Square: 15.5; p < 0.001). Our study confirms the mixed, but shifting, transmission routes during this outbreak. It also highlights the spatial and temporal analytical methods, which can be employed in future outbreaks to improve understanding of HEV transmission.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail: ; Department of Clinical Microbiology, Radboud UMC, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands; † These first authors contributed equally to the work
| | - Lutz Ehlkes
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail: ; Gesundheitsamt, Kölner Str. 180, Düsseldorf, Germany; † These first authors contributed equally to the work
| | - Dawn Taylor
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail:
| | - Jean-Francois Fesselet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail:
| | | | - Abdelkhadir Ahamat
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Alexandra Chen
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Idriss Noh
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Abakar Moustapha
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Alexander Spina
- College of Medicine and Health, St Luke's Campus, Exeter University, Heavitree Road, Exeter, United Kingdom
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27
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Modiyinji AF, Sanding GMAM, Atsama MA, Monamele CG, Nola M, Njouom R. Serological and molecular investigation of hepatitis E virus in pigs reservoirs from Cameroon reveals elevated seroprevalence and presence of genotype 3. PLoS One 2020; 15:e0229073. [PMID: 32040501 PMCID: PMC7010275 DOI: 10.1371/journal.pone.0229073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Hepatitis E virus (HEV) is a zoonotic pathogen of which pigs have been established as reservoirs. In the present study, we investigated the presence of HEV among pigs in the Center and Littoral regions of Cameroon and performed the molecular characterization of positive strains. Methodology A total of 453 serum and stool samples were randomly collected from pigs in slaughterhouses in Obala, Douala and Yaounde. All samples were examined for the presence of anti-HEV IgG and IgM antibodies using ELISA assays. IgM positive stool samples were tested for HEV RNA using an RT-PCR assay, followed by a nested PCR assay for sequencing and phylogenetic analysis. Results Overall, 216 samples (47.7%, 95% CI: 43.1%-52.3%) were positive for at least one of the serological markers of HEV infection. Amongst these, 21.0% were positives for anti-HEV IgM, 17.7% for anti-HEV IgG, and 9.1% for both. A total of eight stool samples (5.9%) were positive for HEV RNA by nested RT-PCR. Phylogenetic analysis showed that the retrieved sequences clustered within HEV genotype 3. Conclusion This study shows a high prevalence of anti-HEV antibodies and the circulation of genotype 3 in the swine population in Cameroon. Subsequent studies will be needed to elucidate the zoonotic transmission of HEV from pigs to humans in Cameroon.
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Affiliation(s)
- Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | | | | | - Moise Nola
- Department of Animals Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail:
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28
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Bono MS, Beasley S, Hanhauser E, Hart AJ, Karnik R, Vaishnav C. Fieldwork-based determination of design priorities for point-of-use drinking water quality sensors for use in resource-limited environments. PLoS One 2020; 15:e0228140. [PMID: 31978158 PMCID: PMC6980542 DOI: 10.1371/journal.pone.0228140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/08/2020] [Indexed: 01/16/2023] Open
Abstract
Improved capabilities in microfluidics, electrochemistry, and portable assays have resulted in the development of a wide range of point-of-use sensors intended for environmental, medical, and agricultural applications in resource-limited environments of developing countries. However, these devices are frequently developed without direct interaction with their often-remote intended user base, creating the potential for a disconnect between users' actual needs and those perceived by sensor developers. As different analytical techniques have inherent strengths and limitations, effective measurement solution development requires determination of desired sensor attributes early in the development process. In this work, we present our findings on design priorities for point-of-use microbial water sensors based on fieldwork in rural India, as well as a guide to fieldwork methodologies for determining desired sensor attributes. We utilized group design workshops for initial identification of design priorities, and then conducted choice-based conjoint analysis interviews for quantification of user preferences among these priorities. We found the highest user preference for integrated reporting of contaminant concentration and recommended actions, as well as significant preferences for mostly reusable sensor architectures, same-day results, and combined ingredients. These findings serve as a framework for future microbial sensor development and a guide for fieldwork-based understanding of user needs.
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Affiliation(s)
- Michael S. Bono
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Sydney Beasley
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Technology and Policy Program, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Emily Hanhauser
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - A. John Hart
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Rohit Karnik
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Chintan Vaishnav
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, United States of America
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29
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Stakeholder Legitimization of the Provision of Emergency Centralized Accommodations to Displaced Persons. SUSTAINABILITY 2019. [DOI: 10.3390/su12010284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sudden population influxes into cities—such as those seen during post-disaster migration—place unexpected demands on the urban housing system. Decisions made during these influxes are often controversial, potentially hindering the ability of the organizations involved to respond. This study’s objective was to explore strategies (e.g., types of information shared and types of accommodation chosen) that can be used during decision-making processes when providing emergency accommodations to increase stakeholder acceptance, and thus lead to sustainable institutional responses. This study specifically sought to shed light on how, during the Refugee Crisis in Germany of 2015 and 2016, stakeholders legitimized decisions made to provide centralized emergency accommodations to displaced persons. Making this study possible were 25 semi-structured interviews with utility, government, nonprofit, and company employees involved in the provision of centralized accommodations for displaced persons. Interviews were conducted in 2016 and underwent a qualitative analysis. Results indicate that stakeholders primarily legitimized the provision of centralized accommodations based on convictions of right and wrong (moral legitimacy), while they legitimized decisions to not provide such accommodations based on their understanding and experience of practical barriers (cultural-cognitive legitimacy). Recommendations arising from this study include the following: provide information to stakeholders about accommodations’ livability (to gain consequential legitimacy) and past successes (to gain comprehensibility legitimacy), adapt regulations to help stakeholders use procedural legitimacy, and prefer fully renovated buildings or modular housing to buildings with no major renovations or container housing (to gain consequential rather than procedural legitimacy).
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30
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Azman AS, Ciglenecki I, Wamala JF, Lynch J, Aggarwal R, Rahman M, Wong S, Serafini M, Moussa AM, Dalton HR, Shrestha A, Pant R, Peck R, Gurley ES. Hepatitis E should be considered a neglected tropical disease. PLoS Negl Trop Dis 2019; 13:e0007453. [PMID: 31344038 PMCID: PMC6657817 DOI: 10.1371/journal.pntd.0007453] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Médecins Sans Frontières, Geneva, Switzerland
- * E-mail:
| | | | | | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Sid Wong
- Medical Department, Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Ali M. Moussa
- Chad Ministry of Health, Department of Communicable Diseases, N’Djamena, Chad
| | | | | | | | - Raquel Peck
- World Hepatitis Alliance, London, United Kingdom
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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31
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Nelson KE, Labrique AB, Kmush BL. Epidemiology of Genotype 1 and 2 Hepatitis E Virus Infections. Cold Spring Harb Perspect Med 2019; 9:a031732. [PMID: 29735579 PMCID: PMC6546036 DOI: 10.1101/cshperspect.a031732] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hepatitis E virus (HEV) genotypes 1 and 2 are responsible for the majority of acute viral hepatitis infections in endemic areas in South Asia and sub-Saharan Africa. In addition to frequent sporadic illnesses throughout the year, these viruses often cause large epidemics in association with monsoon rains in Asia or during humanitarian crises in Africa. Clinical hepatitis commonly involves adults more often than young children, with an overall mortality of ∼1%. However, the mortality among pregnant women is often 30% or higher. HEV infection in pregnant women frequently leads to infant mortality or premature delivery. Hepatitis E is an important, yet largely neglected, global public health problem.
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Affiliation(s)
- Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205
| | - Alain B Labrique
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205
| | - Brittany L Kmush
- Department of Public Health, Food Studies, and Nutrition, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York 13244
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32
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Kumar T, Shrivastava A, Bhatia D, Mitra Y, Kumar A, Hussain S, Chauhan LS, Laserson KF, Narain JP, Kumar R, Francisco A. Jaundice outbreak likely caused by HEV in Amritsar, Punjab, India, 2013. BMC Public Health 2019; 19:464. [PMID: 32326917 PMCID: PMC6696666 DOI: 10.1186/s12889-019-6786-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days. Methods We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013. Results A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2–7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2–11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus. Conclusions Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.
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Affiliation(s)
- Tripurari Kumar
- National Centre for Disease Control, 22-Sham Nath Marg, Delhi, 110054, India.
| | - Aakash Shrivastava
- National Centre for Disease Control, 22-Sham Nath Marg, Delhi, 110054, India
| | - Deepak Bhatia
- Department of Health and Family Welfare, Chandigarh, Punjab, India
| | - Yash Mitra
- Department of Health and Family Welfare, Chandigarh, Punjab, India
| | - Anil Kumar
- National Centre for Disease Control, 22-Sham Nath Marg, Delhi, 110054, India
| | | | | | - Kayla F Laserson
- India-Centers for Disease Control and Prevention, Delhi, India.,Centers for Disease Control and Prevention, Atlanta, USA
| | - Jai Prakash Narain
- National Centre for Disease Control, 22-Sham Nath Marg, Delhi, 110054, India
| | - Rajesh Kumar
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
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(Re-) conceptualising vulnerability as a part of risk in global health emergency response: updating the pressure and release model for global health emergencies. Emerg Themes Epidemiol 2019; 16:2. [PMID: 31007703 PMCID: PMC6454779 DOI: 10.1186/s12982-019-0084-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/03/2019] [Indexed: 12/31/2022] Open
Abstract
Vulnerability has become a key concept in emergency response research and is being critically discussed across several disciplines. While the concept has been adopted into global health, its conceptualisation and especially its role in the conceptualisation of risk and therefore in risk assessments is still lacking. This paper uses the risk concept pioneered in hazard research that assumes that risk is a function of the interaction between hazard and vulnerability rather than the neo-liberal conceptualisation of vulnerability and vulnerable groups and communities. By seeking to modify the original pressure and release model, the paper unpacks the representation or lack of representation of vulnerability in risk assessments in global health emergency response and discusses what benefits can be gained from making the underlying assumptions about vulnerability, which are present whether vulnerability is sufficiently conceptualised and consciously included or not, explicit. The paper argues that discussions about risk in global health emergencies should be better grounded in a theoretical understanding of the concept of vulnerability and that this theoretical understanding needs to inform risk assessments which implicitly used the concept of vulnerability. By using the hazard research approach to vulnerability, it offers an alternative narrative with new perspectives on the value and limits of vulnerability as a concept and a tool.
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Legitimization of the Inclusion of Cultural Practices in the Planning of Water and Sanitation Services for Displaced Persons. WATER 2019. [DOI: 10.3390/w11020359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During large and rapid influxes of displaced persons, hosting communities may face challenges in accommodating incoming populations. This study seeks to assess the institutional response to international displacement in developed urban contexts through exploring how stakeholders (de)legitimized (i.e., either withheld or attributed legitimacy to) the inclusion of cultural practices in the planning of water and sanitation for displaced persons. This study is enabled by 28 semi-structured interviews of individuals involved in the accommodation of displaced persons in Germany conducted in 2016. The interview content was qualitatively analyzed to identify the types of decisions made, legitimacy types used to (de)legitimize those decisions, and information used to assess cultural practices. Results indicate that the institutional response to international displacement was most commonly reactive rather than proactive. However, the interviewees demonstrated a willingness to adapt, primarily using their experiences (comprehensibility legitimacy) and moral considerations (procedural legitimacy). Recommendations to stakeholders arising from this study include: (1) improve access to information about displaced persons’ practices and needs in water and sanitation, (2) collect more information by communicating with displaced persons, (3) promote collaborations between involved organizations, (4) monitor organizational changes during the response, and (5) enhance discussions about integration through the built environment.
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Sander AL, Corman VM, Lukashev AN, Drexler JF. Evolutionary Origins of Enteric Hepatitis Viruses. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a031690. [PMID: 29610146 DOI: 10.1101/cshperspect.a031690] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The enterically transmitted hepatitis A (HAV) and hepatitis E viruses (HEV) are the leading causes of acute viral hepatitis in humans. Despite the discovery of HAV and HEV 40-50 years ago, their evolutionary origins remain unclear. Recent discoveries of numerous nonprimate hepatoviruses and hepeviruses allow revisiting the evolutionary history of these viruses. In this review, we provide detailed phylogenomic analyses of primate and nonprimate hepatoviruses and hepeviruses. We identify conserved and divergent genomic properties and corroborate historical interspecies transmissions by phylogenetic comparisons and recombination analyses. We discuss the likely non-recent origins of human HAV and HEV precursors carried by mammals other than primates, and detail current zoonotic HEV infections. The novel nonprimate hepatoviruses and hepeviruses offer exciting new possibilities for future research focusing on host range and the unique biological properties of HAV and HEV.
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Affiliation(s)
- Anna-Lena Sander
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin 10117, Germany.,German Center for Infection Research (DZIF), Germany
| | - Victor Max Corman
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin 10117, Germany.,German Center for Infection Research (DZIF), Germany
| | - Alexander N Lukashev
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, 119991 Moscow, Russia.,Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Preparations, 142782 Moscow, Russia
| | - Jan Felix Drexler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin 10117, Germany.,German Center for Infection Research (DZIF), Germany
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Cooper BS, White LJ, Siddiqui R. Reactive and pre-emptive vaccination strategies to control hepatitis E infection in emergency and refugee settings: A modelling study. PLoS Negl Trop Dis 2018; 12:e0006807. [PMID: 30252843 PMCID: PMC6173446 DOI: 10.1371/journal.pntd.0006807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/05/2018] [Accepted: 09/03/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hepatitis E Virus (HEV) is the leading cause of acute viral hepatitis globally. Symptomatic infection is associated with case fatality rates of ~20% in pregnant women and it is estimated to account for ~10,000 annual pregnancy-related deaths in southern Asia alone. Recently, large and well-documented outbreaks with high mortality have occurred in displaced population camps in Sudan, Uganda and South Sudan. However, the epidemiology of HEV is poorly defined, and the value of different immunisation strategies in outbreak settings uncertain. We aimed to estimate the critical epidemiological parameters for HEV and to evaluate the potential impact of both reactive vaccination (initiated in response to an epidemic) and pre-emptive vaccination. METHODS We analysed data from one of the world's largest recorded HEV epidemics, which occurred in internally-displaced persons camps in Uganda (2007-2009), using transmission dynamic models to estimate epidemiological parameters and assess the potential impact of reactive and pre-emptive vaccination strategies. RESULTS Under baseline assumptions we estimated the basic reproduction number of HEV in three separate camps to range from 3.7 (95% Credible Interval [CrI] 2.8, 5.1) to 8.5 (5.3, 11.4). Mean latent and infectious periods were estimated to be 34 (95% CrI 28, 39) and 40 (95% CrI 23, 71) days respectively. Assuming 90% vaccine coverage, reactive two-dose vaccination of those aged 16-65 years excluding pregnant women (for whom vaccine is not licensed), if initiated after 50 reported cases, led to mean camp-specific reductions in mortality of 10 to 29%. Pre-emptive vaccination with two doses reduced mortality by 35 to 65%. Both strategies were more effective if coverage was extended to groups for whom the vaccine is not currently licensed. For example, two dose pre-emptive vaccination, if extended to include pregnant women, led to mean reductions in mortality of 66 to 82%. CONCLUSIONS HEV has a high transmission potential in displaced population settings. Substantial reductions in mortality through vaccination are expected, even if used reactively. There is potential for greater impact if vaccine safety and effectiveness can be established in pregnant women.
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Affiliation(s)
- Ben S. Cooper
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Lisa J. White
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Hammer CC, Brainard J, Hunter PR. Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: a qualitative systematic review. BMJ Glob Health 2018; 3:e000647. [PMID: 30002920 PMCID: PMC6038842 DOI: 10.1136/bmjgh-2017-000647] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background Communicable diseases are a major concern during complex humanitarian emergencies (CHEs). Descriptions of risk factors for outbreaks are often non-specific and not easily generalisable to similar situations. This review attempts to capture relevant evidence and explore whether it is possible to better generalise the role of risk factors and risk factor cascades these factors may form. Methods A systematic search of the key databases and websites was conducted. Search terms included terms for CHEs (United Nations Office for the Coordination of Humanitarian Affairs definition) and terms for communicable diseases. Due to the types of evidence found, a thematic synthesis was conducted. Results 26 articles met inclusion criteria. Key risk factors include crowded conditions, forced displacement, poor quality shelter, poor water, sanitation and hygiene, lack of healthcare facilities and lack of adequate surveillance. Most identified risk factors do not relate to specific diseases, or are specific to a group of diseases such as diarrhoeal diseases and not to a particular disease within that group. Risk factors are often listed in general terms but are poorly evidenced, not contextualised and not considered with respect to interaction effects in individual publications. The high level of the inter-relatedness of risk factors became evident, demonstrating risk factor cascades that are triggered by individual risk factors or clusters of risk factors. Conclusions CHEs pose a significant threat to public health. More rigorous research on the risk of disease outbreaks in CHEs is needed, from a practitioner and from an academic point of view.
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Affiliation(s)
| | - Julii Brainard
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
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Vernier L, Lenglet A, Hogema BM, Moussa AM, Ariti C, Vollmer S, Irwin A, Alfani P, Sang S, Kamau C. Seroprevalence and risk factors of recent infection with hepatitis E virus during an acute outbreak in an urban setting in Chad, 2017. BMC Infect Dis 2018; 18:287. [PMID: 29940939 PMCID: PMC6020170 DOI: 10.1186/s12879-018-3194-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND From September 2016-April 2017, Am Timan, Chad, experienced a large HEV outbreak in an urban setting with a limited impact in terms of morbidity and mortality. To better understand HEV epidemiology in this context, we estimated the seroprevalence of anti-HEV antibodies (IgM and IgG) and assessed the risk factors for recent HEV infections (positive anti-HEV IgM) during this outbreak. METHODS A serological survey using simple random sampling was implemented in Am Timan at the tail-end of the outbreak (sample size aim = 384 household). Household members provided us with blood samples and household heads answered questions around water, sanitation and hygiene practices and animal ownership. Blood samples were tested for HEV IgG and IgM antibodies using Enzyme-Immune-Assay (EIA). We calculated weighted prevalence estimates and prevalence ratios (PRs) for possible risk factors for recent infection using multivariate Cox regression. RESULTS We included 241 households (1529 participants). IgM prevalence decreased with age: 12.6% (< 5 years) to 4.3% (> 15 years). IgG prevalence increased with age: 23.5% (< 5 years) to 75.9% (> 15 years). Risk factors for recent HEV infections included: sharing the sanitation facility with other HHs (PR 1.72; 95%CI: 1.08-2.73), not systematically using soap for HW (PR 1.85; 95%CI: 1.30-2.63) and having animals sleeping inside the compound (PR 1.69; 95%CI: 1.15-2.50). CONCLUSIONS Evidence suggests that Am Timan was already highly endemic for HEV before the outbreak, potentially explaining the limited extent of the outbreak. Recent infection with HEV was linked to household level exposures. Future HEV outbreak response must include ensuring access to safe water, and reducing household level transmission through active hygiene and sanitation promotion activities.
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Affiliation(s)
- Larissa Vernier
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Quartier Aeroport, A1, Rue 1039, Porte 405, BP30, N’Djamena, Chad
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD Amsterdam, the Netherlands
| | - Annick Lenglet
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD Amsterdam, the Netherlands
| | - Boris M. Hogema
- Sanquin Diagnostic Services, Department of Virology, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
| | | | - Cono Ariti
- Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT UK
| | - Simone Vollmer
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Quartier Aeroport, A1, Rue 1039, Porte 405, BP30, N’Djamena, Chad
| | - Andrea Irwin
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Quartier Aeroport, A1, Rue 1039, Porte 405, BP30, N’Djamena, Chad
| | - Prince Alfani
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Quartier Aeroport, A1, Rue 1039, Porte 405, BP30, N’Djamena, Chad
| | - Sibylle Sang
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD Amsterdam, the Netherlands
| | - Charity Kamau
- Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD Amsterdam, the Netherlands
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Tritz SE, Khounvisith V, Pommasichan S, Ninnasopha K, Keosengthong A, Phoutana V, Camoin M, Hübschen JM, Black AP, Muller CP, Snoeck CJ, Pauly M. Evidence of increased Hepatitis E virus exposure in Lao villagers with contact to ruminants. Zoonoses Public Health 2018; 65:690-701. [PMID: 29888475 DOI: 10.1111/zph.12483] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/28/2018] [Accepted: 05/03/2018] [Indexed: 02/06/2023]
Abstract
Although pigs are the main reservoir, ruminants have also been shown to be susceptible to hepatitis E virus (HEV). We investigated zoonotic transmission of HEV in rural settings of Lao People's Democratic Republic (Lao PDR) where humans are in close contacts with ruminants and where pigs are rare. Villagers with (n = 171, risk group) and without (n = 155, control group) cattle were recruited in seven villages in Vientiane Capital. Owners of pigs were excluded. Blood, as well as information on socio-demographics, animal contact, dietary habits and awareness of zoonoses were collected to assess risk factors. Blood and rectal swabs were collected from cattle (n = 173) and other ruminants (27 goat, 5 buffaloes) to measure anti-HEV antibody and virus prevalence. A similar anti-HEV antibody seroprevalence was found in cattle (6.8%) and other ruminants (8%). HEV RNA was detected in none of the animal rectal swabs and human sera. Anti-HEV IgG seroprevalence was higher in cattle farmers than in the control group (59.1% vs. 43.9%, p = 0.008) and increased significantly with age. Other risk factors included male gender, close contact with cattle and consumption of undercooked meat. We find that HEV is highly endemic in rural Laos and provide first evidence that HEV circulates in free-roaming ruminants with open access to village water sources. Despite some awareness about hygiene, villagers are likely constantly exposed to zoonotic diseases by dietary and lifestyle habits. Cattle farmers had a higher risk of HEV infection than other villagers. Our study highlights the need to raise the awareness of the rural population about water- and food-borne pathogens, and about the role of cattle as a possible source of infection. The knowledge gained on local risk factors and husbandry conditions should guide future awareness raising campaigns and promote appropriate hygienic measures including handwashing and the consumption of safe food and water.
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Affiliation(s)
- Silvia E Tritz
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Vilaysone Khounvisith
- Lao-Lux-Laboratory, Institute Pasteur du Laos, Vientiane, Lao People's Democratic Republic
| | - Sisavath Pommasichan
- The Faculty of Agriculture, National University of Laos - Nabong Campus, Vientiane, Lao People's Democratic Republic
| | - Khampasong Ninnasopha
- The Faculty of Agriculture, National University of Laos - Nabong Campus, Vientiane, Lao People's Democratic Republic
| | - Amphone Keosengthong
- The Faculty of Agriculture, National University of Laos - Nabong Campus, Vientiane, Lao People's Democratic Republic
| | - Vannaphone Phoutana
- The Faculty of Agriculture, National University of Laos - Nabong Campus, Vientiane, Lao People's Democratic Republic
| | - Margot Camoin
- Veterinarians without Borders-Canada, Ottawa, Ontario, Canada
| | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Antony P Black
- Lao-Lux-Laboratory, Institute Pasteur du Laos, Vientiane, Lao People's Democratic Republic
| | - Claude P Muller
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg.,Lao-Lux-Laboratory, Institute Pasteur du Laos, Vientiane, Lao People's Democratic Republic.,Laboratoire National de Santé, Dudelange, Luxembourg
| | - Chantal J Snoeck
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Maude Pauly
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
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Abstract
Hepatitis E virus genotype 1 (HEV G1) is an important cause of morbidity and mortality in Africa and Asia. HEV G1's natural history, including the incubation period, remains poorly understood, hindering surveillance efforts and effective control. Using individual-level data from 85 travel-related HEV G1 cases in England and Wales, we estimate the incubation period distribution using survival analysis methods, which allow for appropriate inference when only time ranges, rather than exact times are known for the exposure to HEV and symptom onset. We estimated a 29.8-day (95% confidence interval (CI) 24.1–36.0) median incubation period with 5% of people expected to develop symptoms within 14.3 days (95% CI 10.1–21.7) and 95% within 61.9 days (95% CI 47.4–74.4) of exposure. These estimates can help refine clinical case definitions and inform the design of disease burden and intervention studies.
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Abstract
At least 20 million hepatitis E virus (HEV) infections occur annually, with >3 million symptomatic cases and ∼60,000 fatalities. Hepatitis E is generally self-limiting, with a case fatality rate of 0.5-3% in young adults. However, it can cause up to 30% mortality in pregnant women in the third trimester and can become chronic in immunocompromised individuals, such as those receiving organ transplants or chemotherapy and individuals with HIV infection. HEV is transmitted primarily via the faecal-oral route and was previously thought to be a public health concern only in developing countries. It is now also being frequently reported in industrialized countries, where it is transmitted zoonotically or through organ transplantation or blood transfusions. Although a vaccine for HEV has been developed, it is only licensed in China. Additionally, no effective, non-teratogenic and specific treatments against HEV infections are currently available. Although progress has been made in characterizing HEV biology, the scarcity of adequate experimental platforms has hampered further research. In this Review, we focus on providing an update on the HEV life cycle. We will further discuss existing cell culture and animal models and highlight platforms that have proven to be useful and/or are emerging for studying other hepatotropic (viral) pathogens.
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Affiliation(s)
- Ila Nimgaonkar
- Department of Molecular Biology, Princeton University, Lewis Thomas Laboratory, Washington Road, Princeton, New Jersey 08544, USA
| | - Qiang Ding
- Department of Molecular Biology, Princeton University, Lewis Thomas Laboratory, Washington Road, Princeton, New Jersey 08544, USA
| | - Robert E Schwartz
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Lewis Thomas Laboratory, Washington Road, Princeton, New Jersey 08544, USA
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Ifeorah IM, Faleye TOC, Bakarey AS, Adewumi MO, Akere A, Omoruyi EC, Ogunwale AO, Adeniji JA. Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria. J Pathog 2017; 2017:4067108. [PMID: 29387489 PMCID: PMC5745689 DOI: 10.1155/2017/4067108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/23/2017] [Indexed: 12/23/2022] Open
Abstract
Hepatitis E virus (HEV) remains a major public health concern in resource limited regions of the world. Yet data reporting is suboptimal and surveillance system is inadequate. In Nigeria, there is dearth of information on prevalence of acute HEV infection. This study was therefore designed to describe acute HEV infection among antenatal clinic attendees and community dwellers from two geographical regions in Nigeria. Seven hundred and fifty plasma samples were tested for HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) technique. The tested samples were randomly selected from a pool of 1,115 blood specimens previously collected for viral hepatitis studies among selected populations (pregnant women, 272; Oyo community dwellers, 438; Anambra community dwellers, 405) between September 2012 and August 2013. One (0.4%) pregnant woman in her 3rd trimester had detectable HEV IgM, while community dwellers from the two study locations had zero prevalence rates of HEV IgM. Detection of HEV IgM in a pregnant woman, especially in her 3rd trimester, is of clinical and epidemiological significance. The need therefore exists for establishment of a robust HEV surveillance system in Nigeria and especially amidst the pregnant population in a bid to improve maternal and child health.
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Affiliation(s)
- I. M. Ifeorah
- Department of Medical Laboratory Sciences, Faculty of Health Science and Technology, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - T. O. C. Faleye
- Department of Microbiology, Faculty of Science, Ekiti State University, Ado Ekiti, Nigeria
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A. S. Bakarey
- Institute for Advanced Medical Research & Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M. O. Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A. Akere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - E. C. Omoruyi
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A. O. Ogunwale
- Oyo State College of Agriculture and Technology, Igboora, Nigeria
| | - J. A. Adeniji
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Spina A, Lenglet A, Beversluis D, de Jong M, Vernier L, Spencer C, Andayi F, Kamau C, Vollmer S, Hogema B, Irwin A, Ngueremi Yary R, Mahamat Ali A, Moussa A, Alfani P, Sang S. A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017. PLoS One 2017; 12:e0188240. [PMID: 29176816 PMCID: PMC5703542 DOI: 10.1371/journal.pone.0188240] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/05/2017] [Indexed: 12/27/2022] Open
Abstract
Background In September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting. Methods Active case finding using a community based surveillance network identified suspected AJS cases. Pregnant or visibly ill AJS cases presenting at hospital were tested with Assure® IgM HEV rapid diagnostic tests (RDTs) and some with Polymerase Chain Reaction (PCR) in Amsterdam; confirmed cases were RDT-positive and controls were RDT-negative. All answered questions around: demographics, household makeup, area of residence, handwashing practices, water collection behaviour and clinical presentation. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI). Results Between September and April 2017, 1443 AJS cases (1293 confirmed) were detected in the town(attack rate: 2%; estimated 65,000 population). PCR testing confirmed HEV genotype 1e. HEV RDTs were used for 250 AJS cases; 100 (40%) were confirmed. Risk factors for HEV infection, included: having at least two children under the age of 5 years (OR 2.1, 95%CI 1.1–4.3), having another household member with jaundice (OR 2.4, 95%CI 0.90–6.3) and, with borderline significance, living in the neighbourhoods of Riad (OR 3.8, 95%CI 1.0–1.8) or Ridina (OR 3.3, 95%CI 1.0–12.6). Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4–7.9) than controls; possibly due to selection bias. Cases were non-significantly less likely to report always washing hands before meals compared with controls (OR 0.33, 95%CI 0.1–1.1). Discussion Our study suggests household factors and area of residence (possibly linked to access to water and sanitation) play a role in HEV transmission; which could inform future outbreak responses. Ongoing sero-prevalence studies will elucidate more aspects of transmission dynamics of this virus with genotype 1e.
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Affiliation(s)
- Alexander Spina
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
- Department for Infectious Disease Epidemiology and Surveillance, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Annick Lenglet
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Amsterdam, The Netherlands
- * E-mail:
| | - David Beversluis
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Marja de Jong
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Larissa Vernier
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Craig Spencer
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Fred Andayi
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Charity Kamau
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Amsterdam, The Netherlands
| | - Simone Vollmer
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Boris Hogema
- Department of Virology, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Andrea Irwin
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Roger Ngueremi Yary
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | | | - Ali Moussa
- Ministère de la Santé Publique, N’djamena, Chad
| | - Prince Alfani
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Ndjamena, Chad
| | - Sibylle Sang
- Médecins Sans Frontières, Operational Center Amsterdam (OCA), Amsterdam, The Netherlands
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44
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Cohen A, Colford JM. Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:1362-1377. [PMID: 29016318 PMCID: PMC5817760 DOI: 10.4269/ajtmh.17-0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.
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Affiliation(s)
- Alasdair Cohen
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
- Department of Environmental Science, Policy and Management, University of California at Berkeley, Berkeley, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
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45
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Sazzad HMS, Luby SP, Labrique AB, Kamili S, Hayden TM, Kamili NA, Teo CG, Gurley ES. Risk Factors Associated with Blood Exposure for Sporadic Hepatitis E in Dhaka, Bangladesh. Am J Trop Med Hyg 2017; 97:1437-1444. [PMID: 28820721 PMCID: PMC5817767 DOI: 10.4269/ajtmh.17-0261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Abstract
Fecal contamination of drinking water is associated with large hepatitis E virus (HEV) outbreaks of genotypes 1 and 2 in endemic areas. Sporadic transmission of HEV genotypes 3 and 4 in high-income countries has been associated with exposure to blood and animal contact. The objective of the study was to identify the risk factors for hepatitis E and the genotype(s) causing sporadic hepatitis E in Dhaka, Bangladesh. We selected, from a diagnostic center in Dhaka between November 2008 and November 2009, cases presenting with jaundice and anti-HEV IgM antibodies and age-matched controls were defined as those with no history of jaundice and normal blood test results. Serum samples were tested for HEV RNA using real-time reverse transcriptase polymerase chain reaction followed by a sequencing and phylogenetic analysis. A total of 109 cases and 109 controls were enrolled. The cases were more likely to be male (adjusted matched odds ratios [mOR] 2.2, 95% CI: 1.2-3.9; P = 0.01), or have reported contact with another person's blood or blood product, or contact with blood-contaminated sharp instruments (adjusted mOR 2.1, 95% CI: 1.1-4.1; P = 0.03) than controls. There were no significant differences between the cases and the controls in terms of reported high-risk sexual intercourse, consumption of undercooked meat, or contact or drinking fecally-contaminated water. The sera from three cases carried HEV RNA, all belonging to genotype 1. Findings from this study suggest that contact with human blood and sharing sharp instruments may transmit sporadic hepatitis E in Dhaka, Bangladesh. Efforts to prevent the transmission of blood-borne pathogens may also prevent sporadic HEV transmission in this endemic setting.
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Affiliation(s)
| | - Stephen P. Luby
- icddr,b, Dhaka, Bangladesh
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Stanford University, Stanford, California
| | - Alain B. Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tonya M. Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nourine A. Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chong-Gee Teo
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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46
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Abstract
PURPOSE OF REVIEW Infection with the hepatitis E virus (HEV) is very common worldwide. The epidemiology, viral genotypes, and transmission routes differ between low-resource countries and economically developed countries. These differences have resulted in the design of diverse prevention and treatment strategies to combat HEV. RECENT FINDINGS The population seroprevalence of HEV immunoglobulin G varies between 5 and 50%. However, the diagnosis of acute hepatitis from HEV has not been common in the United States or Western Europe. Chronic progressive HEV infections have been reported among patients who are immunocompromised. Successful treatment of patients with chronic hepatitis from HEV infection with antiviral agents, such as ribavirin or interferon-α, has been reported. Extrahepatic manifestations of HEV infection are common. Large epidemics of hundreds or thousands of cases continue to be reported among populations in Asia and Africa. A subunit peptide HEV vaccine has been found to be highly efficacious in a large clinical trial. However, the vaccine has not been evaluated in populations of pregnant women or other risk groups and is only available in China. SUMMARY Although HEV infections are increasingly recognized as a global public health problem, there are few methods for prevention and treatment that are widely available.
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47
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García-Hernández ME, Cruz-Rivera M, Sánchez-Betancourt JI, Rico-Chávez O, Vergara-Castañeda A, Trujillo ME, Sarmiento-Silva RE. Seroprevalence of anti-hepatitis E virus antibodies in domestic pigs in Mexico. BMC Vet Res 2017; 13:289. [PMID: 28934965 PMCID: PMC5609016 DOI: 10.1186/s12917-017-1208-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/14/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) infection is one of the most common causes of acute liver diseases in humans worldwide. In developing countries, HEV is commonly associated with waterborne outbreaks. Conversely, in industrialized countries, HEV infection is often associated with travel to endemic regions or ingestion of contaminated animal products. Limited information on both, human and animal HEV infection in Mexico is available. As a consequence, the distribution of the virus in the country is largely unknown. Here, we assessed the seroprevalence of HEV among swine in different geographical regions in Mexico. METHODS Seroprevalence of anti-HEV antibodies in swine herds in Mexico was evaluated in a representative sample including 945 pig serum specimens from different regions of the country using a commercial enzyme-linked immunosorbent assay (ELISA). RESULTS The overall prevalence of anti-HEV antibodies in swine was 59.4%. The northern region of Mexico exhibited the highest seroprevalence in the country (86.6%), while the central and southern regions in Mexico showed lower seroprevalence, 42.7% and 51.5%, respectively. CONCLUSIONS In Mexico, HEV seroprevalence in swine is high. Importantly, northern Mexico showed the highest seroprevalence in the country. Thus, further studies are required to identify the risk factors contributing to HEV transmission among pigs in the country. Assessment of HEV human infection in the context of viral transmission in swine is required to better understand the epidemiology of hepatitis E in Mexico.
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Affiliation(s)
| | - Mayra Cruz-Rivera
- Facultad de Medicina, Universidad Nacional Autónoma de México, 04510, Ciudad de México, México
| | - José Iván Sánchez-Betancourt
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, 04510, México
| | - Oscar Rico-Chávez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, 04510, México
| | - Arely Vergara-Castañeda
- Facultad de Ciencias Químicas, Universidad La Salle, Benjamín Franklin 47, 06140, Ciudad de México, México
| | - María E Trujillo
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, 04510, México
| | - Rosa Elena Sarmiento-Silva
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, 04510, México.
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48
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Abstract
Hepatitis E virus (HEV) is globally prevalent with relatively high percentages of anti-HEV immunoglobulin G-positive individuals in the populations of developing and developed countries. There are two distinct epidemiologic patterns of hepatitis E. In areas with high disease endemicity, primarily developing countries in Asia and Africa, this disease is caused mainly by genotype 1 or 2 HEV, both of which transmit predominantly through contaminated water and occur as either outbreaks or as sporadic cases of acute hepatitis. The acute hepatitis caused by either of these two genotypes has the highest attack rate in young adults, and the disease is particularly severe among pregnant women. In developed countries, sporadic cases of locally acquired genotype 3 or 4 HEV infection are observed. The reservoir of genotype 3 and 4 HEV is believed to be animals, such as pigs, with zoonotic transmission to humans. The affected persons are often elderly, and persistent infection has been well documented among immunosuppressed persons. A subunit vaccine has been shown to be effective in preventing clinical disease and has been licensed in China.
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Affiliation(s)
- Yansheng Geng
- School of Public Health, Hebei University, No. 342 Yuhuadonglu, Baoding, 071000, China.
| | - Youchun Wang
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, National Institutes for Food and Drug Control, No. 2 Tiantanxili, Dongcheng District, Beijing, 100050, China
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49
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Mauceri C, Grazia Clemente M, Castiglia P, Antonucci R, Schwarz KB. Hepatitis E in Italy: A silent presence. J Infect Public Health 2017; 11:1-8. [PMID: 28864359 DOI: 10.1016/j.jiph.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 01/18/2023] Open
Abstract
Hepatitis E virus (HEV) was discovered in the 1980s and has been considered as being confined to developing countries. The purpose of this critical review was to determine the reported HEV seroprevalence rates in Italy, to identify predisposing factors and individuals at risk and to assess possible importation of HEV by immigrants. A critical review of 159 articles published in PubMed from 1994 to date was done. Only 27 original reports of 50 or more subjects, written in the English or Italian language, were included. Over three decades, the HEV seroprevalence varied from 0.12% to 49%, with the highest rates being reported from the central region of Italy. Risk factors included ingestion of raw pork or potentially contaminated food. The seroprevalence among immigrants ranged from 15.3% to 19.7% in Apulia. Italy has a population of 60656000; the total number of individuals surveyed was only 21.882 (0.036%). A national epidemiological survey program is needed to capture more comprehensive seroprevalence data.
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Affiliation(s)
- Carlo Mauceri
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Maria Grazia Clemente
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Paolo Castiglia
- Department of Biomedical Sciences-Hygiene and Preventive Medicine Unit, University-AOU of Sassari, 07100 Sassari, Italy.
| | - Roberto Antonucci
- Pediatric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari Medical School, 07100 Sassari, Italy.
| | - Kathleen B Schwarz
- Pediatric Liver Center, Johns Hopkins University School of Medicine, Baltimore 21287, MD, USA.
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50
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Azman AS, Bouhenia M, Iyer AS, Rumunu J, Laku RL, Wamala JF, Rodriguez-Barraquer I, Lessler J, Gignoux E, Luquero FJ, Leung DT, Gurley ES, Ciglenecki I. High Hepatitis E Seroprevalence Among Displaced Persons in South Sudan. Am J Trop Med Hyg 2017; 96:1296-1301. [PMID: 28719276 PMCID: PMC5462562 DOI: 10.4269/ajtmh.16-0620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AbstractLarge protracted outbreaks of hepatitis E virus (HEV) have been documented in displaced populations in Africa over the past decade though data are limited outside these exceptional settings. Serological studies can provide insights useful for improving surveillance and disease control. We conducted an age-stratified serological survey using samples previously collected for another research study from 206 residents of an internally displaced person camp in Juba, South Sudan. We tested serum for anti-HEV antibodies (IgM and IgG) and estimated the prevalence of recent and historical exposure to the virus. Using data on individuals' serostatus, camp arrival date, and state of origin, we used catalytic transmission models to estimate the relative risk of HEV infection in the camp compared with that in the participants' home states. The age-adjusted seroprevalence of anti-HEV IgG was 71% (95% confidence interval = 63-78), and 4% had evidence of recent exposure (IgM). We estimated HEV exposure rates to be more than 2-fold (hazard ratio = 2.3, 95% credible interval = 0.3-5.8) higher in the camp than in the participants' home states, although this difference was not statistically significant. HEV transmission may be higher than previously appreciated, even in the absence of reported cases. Improved surveillance in similar settings is needed to understand the burden of disease and minimize epidemic impact through early detection and response.
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Affiliation(s)
- Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Anita S Iyer
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - John Rumunu
- South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Epicentre, Paris, France
| | - Daniel T Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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